Methods for identifying modulators of membrane potentials in bipolar disorder and attention deficit hyperactivity disorder

ABSTRACT

The present invention provides methods to modulate key elements along the DAG signaling pathway as well as a diagnostic assay, device and methods of using the same to diagnose bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD). Methods to identify diagnostic markers and drug targets for BD and ADHD. Methods of identifying effective compounds responsible for membrane potentials and excitabilities influencing bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD). Methods of identifying an effective compound that modulates the activity of Ca 2+ /CaM enzyme and compounds involved in changing the K +  gradient across the plasma membrane thereby increasing or decreasing the membrane potential ratio (MPR™) values. The invention provides methods of identifying a compound that modulates the activity of PKC which is an important protein of the DAG signaling pathway. Methods of identifying a compound that modulates DAG and its related enzymes along the DAG signaling pathway are provided. These compounds decrease or increase the membrane potential ratio (MPR™) in BD and ADHD patients.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application Divisional of U.S. application Ser. No. 14/236,787,filed Feb. 3, 2014 (now allowed); which is a National Stage ofInternational Application No. PCT/US2012/055356, filed on Sep. 14, 2012,which claims priority from U.S. Provisional Application No. 61/653,579,filed May 31, 2012, and U.S. Provisional Application No. 61/543,601,filed Oct. 4, 2011, and; the contents of all of which are incorporatedherein by reference in their entirety.

FIELD OF THE INVENTION

The present invention relates to methods of diagnosing and identifyingmodulators of cellular membrane potential in patients with bipolardisorder (BD) and attention deficit hyperactivity disorder (ADHD), aswell as methods of identifying modulators of cellular membrane potentialin patients with BD and ADHD, to serve as diagnostic markers and drugtargets for treatment of BD and ADHD. The present invention relates tomethods of identifying modulators of the diacylglycerol (DAG) signalingpathway as diagnostic markers for diagnosing BD and ADHD, and as drugtargets for treatment of BD and ADHD.

BACKGROUND OF THE INVENTION

The present invention relates to the fields of electrophysiology,molecular biology and molecular medicine, and more specifically toregulation of neuronal membrane potentials and excitabilities involvedin BD and ADHD by polypeptides in the diacylglycerol signaling pathway,and modulation of the same.

The present invention relates to a method of identifying the modulatorsof the membrane potentials of patients' cells that could serve as thedrug targets for decreasing the membrane potential ratio (MPR™) valuesin ADHD patients and for lowering the MPR™ values to the levels of theMPR™ values of negatives. The invention relates to a method ofidentifying the modulators of the membrane potentials of patients' cellsthat could serve as the drug targets for increasing the MPR™ values inBD patients and for raising the MPR™ values to the levels of the MPR™values of negatives. This invention further identifies the DAG signalingpathway as a principal signaling mechanism that modulates the MPR™values. Furthermore this invention identifies modulators such ascompounds and polypeptides along this pathway as diagnostic markers anddrug targets for BD and ADHD. They include DAG and its associatedenzymes and kinases, PKC isoforms and associated enzymes and kinases,and Ca²⁺/CaM and its associated enzymes and kinases.

It is well recognized that mental disorders are caused by themalfunction of the neurons in the brain. Neurons communicate with eachother through electrophysiological signals. These signals are generatedand modulated by the membrane potential and the excitability of theneurons. The identification of the molecules that modulate the signalingpathways in the neuronal cell is essential in diagnosing and treatingmental illness. The membrane potential is the electrical potentialdifference (voltage) across a cell's membrane. Membrane potentialresults from the action of K⁺ ion channels present in the membrane whichalong with the Na, K-ATPase enzyme maintain viable ion concentrationsinside the cell.

Unlike most cells, neurons are electrically active and use changes inmembrane potential for fast communication with other neurons. Neuronsprocess and transmit information in the form of electrical signals. K⁺ion channels in the neuronal membrane set the membrane potentials andthe excitability. These signals are then processed, amplified andtransmitted to the synapse releasing the neurotransmitters. Thesetransmitters again send a signal through their specific G-proteincoupled receptors (GPCR) in the membrane of the target neuron. The GPCRstransmit these signals through two primary signal transduction pathwaysthat process and transmit this signal to the K⁺ ion channels in itsmembrane. These two pathways are the cAMP signaling pathway and the DAGsignaling pathway (Nahorski S. R. British Journal of Pharmacology (2006)147, S38-S45).

Calculations of the membrane potentials (MP) using Goldman-Hodgkin-Katzequation showed that lithium would depolarize the membrane potentials(Thiruvengadam, A. Journal of Affective Disorders 65 (2001) 95-99). Thisresult led to the hypothesis that lithium's therapeutic efficacy was dueto this depolarizing effect. This result was supported by earlierexperimental and clinical results (Yonemura, K, and Sato, M, TheJapanese Journal of Physiology, 1967; 17: 678-97), Grafe, et al, BrainResearch, 1983; 279: 65-76 and El-Mallakh, et al, J. AffectiveDisorders, 1996; 41: 33-3). Thiruvengadam (Focus on Bipolar DisorderResearch ISBN 1-59454-059-4 Editor: Malcomb R. Brown, pp. 15-35 © 2005Nova Science Publishers, Inc.) further showed that lithium not onlydepolarizes the membrane potential but also reduces the excitabilitiesof neurons. Measurement of membrane potentials of cultured lymphoblastscollected from BD patients showed that the membrane potential washyperpolarized confirming the measurements of El Mallakh et al. In orderto use the membrane potential as a diagnostic marker for BD, aratiometric method was developed and used successfully for diagnosing BDpatients (U.S. Pat. No. 7,425,410 B2 which is incorporated herein in itsentirety) using their red blood cells (RBC). This method involves themeasurement of MP from changes that occur in the Na⁺K⁺ ATPase activityin cells, in two buffers and taking the ratio of these two MPs. Theseexperiments involve a test buffer that contains no K⁺ ions but containsethyl alcohol (EtOH). The membrane potentials are measured in the testbuffer and compared with the membrane potentials measured in a referencebuffer without EtOH. This ratio is called the membrane potential ratio(MPR™). It was further discovered that the membrane potential ratio(MPR™) could also be used to diagnose ADHD patients (U.S. Pat. No.7,906,300 B2 which is incorporated herein in its entirety). To date,more than 550 patients have been tested using membrane potential ratio(MPR™). A summary of these test results is shown in FIG. 1. The membranepotential ratio (MPR™) values for BD patients were significantly lowerthan that for negatives (including normals, unipolar depressives, andschizophrenics). On the other hand, the membrane potential ratio (MPR™)values for ADHD patients were significantly higher than that fornegatives as shown in FIG. 1.

It is essential to understand the biological basis for these differencesin order to determine the scientific mechanism(s) and pathway(s)responsible for the differences in the membrane potential ratio (MPR™)among the three groups and to elucidate the pathophysiology of theseillnesses.

Currently drug development efforts utilize neurotransmitters, theirrelease, uptake and activation of their receptors as therapeutic drugtargets for BD and ADHD. However, these drug targets do not serve asdiagnostic biomarkers. The mechanism of action of drugs like lithium,amphetamine and anticonvulsants such as valproate and carbamazepine arenot well understood. The results that the membrane potential ratio(MPR™) values for BD patients are significantly lower than those fornegatives (including normals, unipolar depressives, and schizophrenics)and that the membrane potential ratio (MPR™) values for ADHD patientsare significantly higher than those for negatives (as shown in FIG. 1)are very significant since they for the first time directly connect thespecific patients with mental disorders to the specific biomarkers viachanges that occur in the Na⁺K⁺ ATPase regulation and membrane potentialchanges therein. An understanding of the signaling pathway and theidentification of the polypeptides and compounds modulating Na⁺K⁺ ATPaseregulation was essential in advancing and enabling the diagnosis of BDand ADHD. To date, there are no studies in the art that connect thesignaling pathway, the polypeptides involved, electrophysiologicalparameters such as membrane potentials and excitabilities with mentaldisorders such as BD and ADHD. The present invention accomplishes thisobjective leading to better diagnostics and therapeutics.

CAK Channels and Membrane Potentials In RBC: Although the expression ofone of the small conductance family of CAK channels in RBC has beenknown since 2003 (Hoffman et al, PNAS, 100(12): 7366-7371 (2003); whichis incorporated herein in its entirety), there has been no measurementof the membrane potential in RBC much more an observation of thedifferences among three groups of patient populations (negatives, BD andADHD). The observation that EtOH hyperpolarizes the membrane potentialshas been recognized in the art as a new discovery. However, onlyexperiments using channel blockers, quinine and clotrimazole in RBCestablished this fact. No other literature in the art shows a connectionbetween calcium-activated potassium (CAK) channels and ethanol, nor theinvolvement of CAK channels and cellular membrane potentials.

Ca²⁺/CaM Activation of CAK Channels, EtOH and Membrane Potentials inRBC: It is well-known in the art that CAK channels are activated bycalcium-calmodulin (Ca²⁺/CaM). However, there is nothing in the artdemonstrating the modulation of membrane potentials by either ethanol orby a calmodulin (CaM) activator such as calmodulin (CaM) Kinase II.

PKC, CaM and membrane potentials: It is well-known in the art that PKCthrough the DAG signaling pathway activates calmodulin (CaM). However,no studies in the art have shown that DAG signaling pathway modulatesthe CaK channels and membrane potentials.

DAG, CAK Channels and MP: DAG and the DAG signaling pathway has not beenshown or understood in the art to have an effect on membrane potentials,much more be involved in the diagnosis of BD and ADHD. For instance,U.S. Pat. No. 6,593,121 2003 to Caricasole et al. (which is incorporatedherein by reference in its entirety) relates to human diacylglycerolkinase proteins (hDAGK), and does not address membrane potential ratio(MPR™) differences nor modulation of the membrane potential ratio by theDAG pathway. Baum et al., Mol. Psychiatry 13(2): 197-207 (2008) was agenome-wide association study that implicated the diacylglycerol kinaseeta (DGKH) and several other genes in the etiology of BD. However, Baumdid not recognize that membrane potential ratios (MPR™) may be modulatedby the DAG signaling pathway.

Thus, the present investigator identified an unaddressed need in theart, to determine the signaling pathway(s) and drug targets of thesignaling pathway(s) that regulate cellular membrane potentials toprovide a more specific means of identifying compounds that bind tothese drug targets and modulate the interaction of these drug targets.These signaling pathways and drug targets can then be used fordiagnostic and therapeutic purposes. For instance, the drug targets maybe polypeptides involved in the diacylglycerol signaling pathway.

The present invention satisfies this need and provides relatedadvantages as well. For example, this invention traces the pathway forBD and ADHD from the G-protein coupled receptors (GPCR) to the K⁺channel in patients' cells. The present discovery provides a betterunderstanding of the pathophysiology of these disorders and a bettermeans to diagnosis and treat BD and ADHD.

SUMMARY OF THE INVENTION

The present invention exploits the modulation of membrane potentials incells of patients of BD and ADHD by the diacylglycerol signalingpathway, as well as identification of modulators of the pathway asdiagnostic biomarkers and as targets for drug development.

The membrane potential in cells from ADHD and BD patients aresignificantly different than the membrane potential in cells fromunaffected controls and siblings. For example, the membrane potentialsof bipolar lymphoblasts are significantly hyperpolarized when comparedwith those of siblings and negative controls, whereas the membranepotentials of ADHD lymphoblasts are significantly depolarized whencompared to those of siblings and negative controls. The changes inmembrane potential reflect changes in modulators that regulate thediacylglycerol pathway in cells of patients affected with BD and ADHD.

This invention provides the methods for identifying the effectivecompounds that modulate the DAG signaling pathway which controls theCalcium Activated Potassium (CAK) channels responsible for the membranepotentials and excitabilities influencing bipolar disorder (BD) andattention deficit hyper activity disorder (ADHD).

This invention also provides a method of identifying an effectivecompound that modulates the activity of Ca²⁺/CaM enzyme changing the K⁺gradient across the plasma membrane thereby increasing or decreasing themembrane potential ratio (MPR™) values.

This invention provides a method of identifying a compound thatmodulates the activity of PKC which is an important protein along theDAG signaling pathway.

This invention further provides a method to identify a compound thatmodulates the DAG and its related enzymes along the DAG signalingpathway. These compounds in turn decrease or increase the membranepotential ratio (MPR™) in BD and ADHD patients.

This invention also provides a method to modulate the key elements alongthe DAG signaling pathway and thus provide better diagnostic markers anddrug targets for BD and ADHD.

The invention provides a method of diagnosing bipolar disorder (BD) in ahuman patient. The method involves obtaining a test ratio of a meanmembrane potential of human patient cells incubating a first populationof the human patient cells in vitro in the presence of an agent thatalters diacylglycerol signaling and in the absence of K⁺, to a meanmembrane potential of a second population of the human patient cellsincubated in vitro in the absence of the agent and presence of K⁺. Thetest ratio is compared to (a) and/or (b): in which (a) is a controlratio of a mean membrane potential of control human cells known to nothave said BD, and (b) is a bipolar control ratio of a mean membranepotential of bipolar control human cells known to have BD.

The invention also provides a method of diagnosing attention deficithyperactivity disorder (ADHD) in a human patient. The method involvesobtaining a test ratio of a mean membrane potential in the presence ofan agent that alters diacylglycerol signaling and in the absence of K⁺,to a mean membrane potential of a second population of the human patientcells incubated in vitro in the absence of the agent and presence of K⁺.The test ratio is compared to (a) and/or (b): in which (a) is a controlratio of a mean membrane potential of control human cells known to nothave said ADHD, and (b) is a ADHD control ratio of a mean membranepotential of ADHD control human cells known to have ADHD.

In a preferred embodiment, the agent that alters diacylglycerolsignaling is selected from the group consisting of a calcium-calmodulin(Ca²⁺/CaM) kinase inhibitor and a diacylglycerol kinase inhibitor.

In another preferred embodiment, the agent affects calcium-activatedpotassium (CaK) channels).

The invention further provides a method of identifying an agent fortreatment of bipolar disorder (BD). The method involves combining afirst population of human patient cells and a test agent suspected ofaltering human calcium-activated potassium channels hSK₄ activity.Obtaining a test ratio of a mean membrane potential of the firstpopulation of human patient cells incubated in vitro in the presence ofthe test agent and the presence of K⁺ or absence of K⁺, to a meanmembrane potential of a second population of the human patient cellsincubated in vitro in the absence of the test agent and the presence ofK⁺ or absence of K⁺. The test ratio is compared to (a) and/or (b): inwhich (a) is a control ratio of a mean membrane potential of controlhuman cells known to not have said BD, and (b) is a bipolar controlratio of a mean membrane potential of bipolar control human cells knownto have said BD. When the test ratio is not significantly different fromthe control ratio of (a), the test ratio is increased towards thecontrol ratio in comparison to the bipolar control ratio of (b), or thetest ratio is increased in comparison to the bipolar ratio of (b), thetest agent is determined to modulate the mean membrane potential in BDpatients.

In a preferred embodiment, the agent is selected from the groupconsisting of a calcium-calmodulin (Ca²⁺/CaM) kinase inhibitor and adiacylglycerol kinase inhibitor.

In another embodiment, the agent is a calcium-calmodulin (Ca²⁺/CaM)kinase inhibitor. Specifically, autocamtide-2-related inhibitory peptide(AIP).

In another embodiment, the agent is a diacylglycerol kinase inhibitor.Specifically,6-[2-[4-[(4-fluorophenyl)phenylmethylene]-1-piperidinyl]ethyl]-7-methyl-5H-thiazolo[3,2-a]pyrimidin-5-one(ALX).

The invention further provides a method of identifying an agent fortreatment of attention deficit hyperactivity disorder (ADHD). The methodinvolves combining a first population of human patient cells and a testagent suspected of altering human calcium-activated potassium channelshSK₄ activity. Obtaining a test ratio of a mean membrane potential ofthe first population of human patient cells incubated in vitro in thepresence of the test agent and in the absence of K+, to a mean membranepotential of a second population of the human patient cells incubated invitro in the absence of the test agent and the presence of K⁺ or absenceof K⁺. The test ratio is compared to (a) and/or (b): in which (a) is acontrol ratio of a mean membrane potential of control human cells knownto not have said ADHD, and (b) is an ADHD control ratio of a meanmembrane potential of ADHD control human cells known to have said ADHD.When the test ratio is not significantly different from the controlratio of (a), the test ratio is decreased towards the control ratio of(a) in comparison to (b), or the test ratio is decreased in comparisonto the ADHD control ratio of (b), the test agent is determined tomodulate the mean membrane potential in ADHD patients.

In a preferred embodiment, the agent is selected from the groupconsisting of a calcium-calmodulin (Ca²⁺/CaM) kinase inhibitor, adiacylglycerol kinase inhibitor, and a protein kinase C inhibitor.

In another preferred embodiment, the agent is a PKC inhibitor selectedfrom the group consisting of phorbol 12-myristate 13-acetate (PMA),3-(1H-indol-3-yl)-4-[2-(4-methylpiperazin-1-yl)quinazolin-4-yl]pyrrole-2,5-dione(Sotrastaurin or AEB07), 13-hydroxyoctadecadienoic acid (13-HODE),aprinocarsen, bisindolylmaleimide, bryostatin-1, butein, calphostin C,7,8-dihydroxycoumarin, 4′-demethylamino-4′-hydroxystaurosporine,rottlerin, ruboxistaurin, staurosporine, and verbascoside.

In another preferred embodiment, the agent is a calcium-calmodulin(Ca²⁺/CaM) kinase inhibitor. Specifically, autocamtide-2-relatedinhibitory peptide (AIP).

In another preferred embodiment, the agent is a diacylglycerol kinaseinhibitor. Specifically,6-[2-[4-[(4-fluorophenyl)phenylmethylene]-1-piperidinyl]ethyl]-7-methyl-5H-thiazolo[3,2-a]pyrimidin-5-one(ALX).

Further, the invention provides a method of identifying an agent thatmodulates diacylglycerol signaling for the treatment of bipolar disorder(BD). The method involves combining a first population of human patientcells and a test agent suspected of altering diacylglycerol signaling.Obtaining a test ratio of a mean membrane potential of the firstpopulation of human patient cells incubated in vitro in the presence ofthe test agent and in the absence of K+, to a mean membrane potential ofa second population of the human patient cells incubated in vitro in theabsence of the test agent and in the presence of K⁺ or absence of K⁺.The test ratio is compared to (a) and/or (b): in which (a) is a controlratio of a mean membrane potential of control human cells known to nothave said BD, and (b) is a bipolar control ratio of a mean membranepotential of bipolar control human cells known to have said BD. When thetest ratio is not significantly different from the control ratio of (a),the test ratio is increased towards the control ratio in comparison tothe bipolar control ratio of (b), or the test ratio is increased incomparison to the bipolar ratio of (b), the test agent is determined tomodulate the mean membrane potential in BD patients.

In addition, the invention provides a method of identifying an agentthat modulates diacylglycerol signaling for the treatment of attentiondeficit hyperactivity disorder (ADHD). The method involves combining afirst population of human patient cells and a test agent suspected ofaltering diacylglycerol signaling. Obtaining a test ratio of a meanmembrane potential of the first population of human patient cellsincubated in vitro in the presence of the test agent and in the absenceof K+, to a mean membrane potential of a second population of the humanpatient cells incubated in vitro in the absence of the test agent andthe presence of K⁺ or absence of K⁺. The test ratio is compared to (a)and/or (b): in which (a) is a control ratio of a mean membrane potentialof control human cells known to not have said ADHD, and (b) is an ADHDcontrol ratio of a mean membrane potential of ADHD control human cellsknown to have said ADHD. When the test ratio is not significantlydifferent from the control ratio of (a), the test ratio is decreasedtowards the control ratio of (a) in comparison to (b), or the test ratiois decreased in comparison to the ADHD control ratio of (b), the testagent is determined to modulate the mean membrane potential in ADHDpatients.

In a preferred embodiment, the human cells is selected from the groupconsisting of red blood cells and lymphoblasts.

In a more preferred embodiment, the invention provides for a method ofidentifying an agent for treatment of bipolar disorder (BD) in which thefirst population of human patient cells is combined with a test agentsuspected of altering Ca²⁺/CaM activation of calcium-activated potassiumchannels, the control human cells and the bipolar control human cellsare incubated in vitro in the presence of autocamtide-2-relatedinhibitory peptide (AIP), the human cells are selected from the groupconsisting of red blood cells and lymphoblasts, and the Ca²⁺/CaMactivation of calcium-activated potassium channels depolarizes the meanmembrane potential of the human patient cells.

In another more preferred embodiment, the invention provides for amethod of identifying an agent for treatment of bipolar disorder (BD) inwhich the first population of human patient cells is combined with atest agent suspected of altering diacylglycerol kinase activity, thecontrol human cells and the bipolar control human cells are incubated invitro in the presence of6-[2-[4-[(4-fluorophenyl)phenylmethylene]-1-piperidinyl]ethyl]-7-methyl-5H-thiazolo[3,2-a]pyrimidin-5-one(ALX), and the human cells are selected from the group consisting of redblood cells and lymphoblasts.

In yet another more preferred embodiment, the invention provides for amethod of identifying an agent that modulates diacylglycerol signalingfor the treatment of attention deficit hyperactivity disorder (ADHD) inwhich the first population of human patient cells is combined with atest agent suspected of altering PKC activity, the control human cellsand the bipolar control human cells are incubated in vitro in thepresence of phorbol 12-myristate 13-acetate (PMA), and the human cellsare selected from the group consisting of red blood cells andlymphoblasts.

The present invention also relates to a kit that includes the buffersdescribed herein, and preparation thereof. The kit may be a diagnostickit for diagnosing ADHD or BD, or an agent identifying kit used foridentifying a modulator of diacylglycerol signaling for the treatment ofADHD or BD. For instance, the modulator may include a calcium-calmodulin(Ca²⁺/CaM) kinase inhibitor, a diacylglycerol kinase inhibitor, and aprotein kinase C inhibitor. Preferably, the kit used for identifying amodulator that alters calcium-activated potassium channel activity suchas hSK₄ channel activity.

In a preferred embodiment, the invention relates to a method ofdiagnosing bipolar disorder (BD) in a human patient in which a testratio is obtained from a mean membrane potential of a first populationof human patient cells incubated in vitro in the presence of an agentthat alters K⁺ channel activity and in the absence of K⁺, to a meanmembrane potential of a second population of the human patient cellsincubated in vitro in the absence of the agent that alters K⁺ channelactivity and in the absence of K⁺. The test ratio is compared to (a)and/or (b) in which (a) is a control ratio of a mean membrane potentialof control human cells known to not have said BD incubated in vitro inthe presence of the agent that alters K⁺ channel activity and in theabsence of K⁺, to a mean membrane potential of the control human cellsknown to have said BD incubated in vitro in the absence of the agentthat alters K⁺ channel activity and in the absence of K⁺, and (b) is abipolar control ratio of a mean membrane potential of bipolar controlhuman cells known to have said BD incubated in vitro in the presence ofthe agent that alters K⁺ channel activity and in the absence of K⁺, to amean membrane potential of the bipolar control human cells incubated invitro in the absence of the agent that alters K+ channel activity and inthe absence of K⁺. The mean membrane potential is determined byincubating the cells in vitro in buffer comprising a potential-sensitivedye, resuspending the cells in potential-sensitive dye free-buffer, andmeasuring the cell fluorescence. The human patient is diagnosed to havebipolar disorder when the test ratio obtained is significantly lowerthan the control ratio obtained in (a) and/or the test ratio obtained isnot significantly different from the bipolar control ratio obtained in(b).

In a preferred embodiment, the invention relates to a method ofdiagnosing attention deficit hyperactivity disorder (ADHD) in a humanpatient in which a test ratio is obtained of a mean membrane potentialof a first population of human patient cells incubated in vitro in thepresence of an agent that alters K⁺ channel activity and in the absenceof K⁺, to a mean membrane potential of a second population of the humanpatient cells incubated in vitro in the absence of the agent that altersK⁺ channel activity and in the absence of K⁺. The test ratio is comparedto (a) and/or (b) in which (a) is a control ratio of a mean membranepotential of control human cells known to not have said ADHD incubatedin vitro in the presence of the agent that alters K⁺ channel activityand in the absence of K⁺, to a mean membrane potential of the controlhuman cells known incubated in vitro in the absence of the agent thatalters K⁺ channel activity and in the absence of K⁺, and (b) is abipolar control ratio of a mean membrane potential of ADHD control humancells known to have said ADHD incubated in vitro in the presence of theagent that alters K⁺ channel activity and in the absence of K⁺, to amean membrane potential of the ADHD control human cells incubated invitro in the absence of the agent that alters K⁺ channel activity and inthe absence of K⁺. The mean membrane potential is determined byincubating the cells in vitro in buffer comprising a potential-sensitivedye, resuspending the cells in potential-sensitive dye free-buffer, andmeasuring the cell fluorescence. The human patient is diagnosed to haveADHD when the test ratio obtained is significantly higher than thecontrol ratio obtained in (a) and/or the test ratio obtained is notsignificantly different from the ADHD control ratio obtained in (b).

In an embodiment of the invention, the agent that alters K⁺ channelactivity includes, but is not limited to, ethanol, amphetamine,ephedrine, cocaine, caffeine, nicotine, methylphenidate, lithium,δ-9-tetrahydrocannibinol, phencyclidine, lysergic acid diethylamide(LSD), mescaline, or combinations thereof.

In a preferred embodiment, the agent that alters K⁺ channel activity isethanol.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. Shows the mean values of membrane potential ratios (MPR™) forthe three groups of patients including BD, ADHD and negatives (negativesdo not have either BD or ADHD). The membrane potential ratios (MPR™)values are significantly different from each other. Until this study,the differences in the membrane potential ratio (MPR™) were unclear. Theobjectives of this invention are to determine the cause of thisdifference and to identify the modulator proteins leading to drugtargets and diagnostic markers.

FIG. 2. Shows the effect of quinine and clotrimazole on membranepotential ratio (MPR™).

FIG. 3. Shows the effect of 8-CPT on membrane potential ratio (MPR™).

FIG. 4. Shows the effect of PMA on membrane potential ratio (MPR™).

FIG. 5. Shows the effect of staurosporine on membrane potential ratio(MPR™).

FIG. 6. Shows the effect of AIP-M on membrane potential ratio (MPR™).

FIG. 7. Shows the effect of DGK Inhibitor ALX on membrane potentialratio (MPR™).

DETAILED DESCRIPTION OF THE INVENTION

For convenience, certain terms employed in the specification, examples,and appended claims are collected here. Unless defined otherwise, alltechnical and scientific terms used herein have the same meaning ascommonly understood by one of ordinary skill in the art to which thisinvention belongs.

The articles “a” and “an” are used herein to refer to one or to morethan one (i.e., to at least one) of the grammatical object of thearticle. By way of example, “a human cell” means one human cell or morethan one human cell.

The terms “agent(s)”, “modulator(s)”, “test agent(s)”, and “compound(s)”are used herein interchangeably and are meant to include, but are notlimited to, peptides, nucleic acids, carbohydrates, small organicmolecules, and any other molecules (including, but not limited to,chemicals, metals, and organometallic compounds).

The present invention relates to methods for modulating thediacylglycerol signaling pathway. The present invention provides methodsof identifying compounds for the treatment of BP and ADHD, as well asmethods of treating BP and ADHD with the compounds identified. In thisrespect, the present invention provides methods for identifying targetsfor drug modulation of the diacylglycerol signaling pathway, and methodsof identifying compounds that modulate these targets of thediacylglycerol pathway.

In the experiments described herein, the membrane potentials of humancells such as whole blood cells are ascertained and compared. However,the methods of the present invention may use any cell type, such as, butnot limited to, erythrocytes, lymphoblasts, platelets, leukocytes,macrophages, monocytes, dendritic cells, fibroblasts, epidermal cells,mucosal tissue cells, cells in the cerebrospinal fluid, and hair cells.fs Preferably, cells in blood, skin cells, hair cells, or mucosal tissuecells are used because of the ease of harvesting these cell types.

Membrane Potential Ratio (MPR™) Differences in BD and ADHD: As shown inFIG. 1 the mean values of membrane potential ratio (MPR™) for the BDpatients are significantly lower than that for the Negatives (who areneither BD nor ADHD). Similarly the membrane potential ratio (MPR™)values for the ADHD patients are significantly higher than that for thenegatives. It is essential to understand these differences so that theunderlying pathophysiology of these disorders is better understoodleading to better diagnostic markers and drug targets. “Significantlyhigher”, “significantly lower” or “significantly different” means avalue that is considered significant as determined by the variousstatistical tests and analyses commonly used and known in the art.Membrane potential ratio (MPR™) is the ratio between the membranepotential in the test buffer and that in the reference buffer. Thereference buffer contains NaCl, CaCl₂, glucose and Hepes whereas thetest buffer contains ethyl alcohol (EtOH) in addition to thesecompounds. Both buffers do not contain K⁺ ions. The role of the absenceof K⁺ ions in the buffer on membrane potential and the addition of EtOHneeds to be understood in order to explain their effects.

K⁺ Free Buffer and SK₄ Channels: Gardos discovered as early as 1958 thatthe potassium permeability in RBCs is controlled by thecalcium-activated potassium channel (CAK) called Gardos channel (Gardos,G., Biochim. Biophys. Acta. 30:653-54 (1958)). The Gardos channel hasbeen confirmed as the KCNN4 (International designation for the calciumactivated potassium channels; it is also called hSK₄ in humans)belonging to the family of slow conductance potassium channels (Joineret al, Neurobiology, PNAS, 94: 11013-11018 (1997), which is incorporatedherein in its entirety, and also Hoffman et al, PNAS, 100(12):7366-7371) (2003)). Grygorczyk et al (BIOPHYS. J. Biophysical Society,45: 693-698 (1984)) found that the net efflux of K+ is decreasedsignificantly when RBCs are suspended in K⁺ free buffer implying thatthe hSK₄ channels are closed in the absence of the extracellular K⁺ ion.

Effect of EtOH on hSK₄ Channel: Krjnevic speculated that ethanol,sedatives and hypnotic drugs activated the CaK channels (Krjnevic K(1972) Excitable membranes and anesthetics, in Cellular Biology andToxicity of Anesthetics (Fink B R: ed, pp 3-9. Williams & Wilkins,Baltimore, Md.). Later on, it was shown that ethanol increased K⁺ effluxin CAK channels. Mustonen et al., Scand. J. Gastroenterol. 39(2):104-110 (2004)) showed that the ethanol effect was reversed by quinine,a CaK channel blocker (Reichstein E, Rothstein A., J Membr Biol.59:57-63 (1981)). It is known that clotrimazole (CLTX) is also aneffective blocker of CAK channels (Ohnishi S T, et al, Biochim BiophysActa. 1010:199-203 (1989)). The experiments with hSK₄ blockers quinineand clotrimazole show that the EtOH effect is blocked by these hSK₄channel blockers as shown in FIG. 2. Quinine and clotrimazole were addedto the test buffer and the membrane potential ratio (MPR™) wasdetermined. The membrane potential ratio (MPR™) values are shown in boxplots (FIG. 2). Box 2 shows the increased values of membrane potentialratio (MPR™) with 1 mM quinine in the test buffer as compared to thevalues in box 3 for the test buffer without quinine. Similarly boxes 3,4 and 5 show the results for CLTX.

Box 3 represents no CLTX, while box 4 for 2.5 micro molar CLTX and box 5for 5 micro molar concentrations in the test buffer. These blockersdepolarized the membrane potentials robustly indicating that the hSK₄channels are responsible for the membrane potential ratio (MPR™) inthese tests. This result teaches the POSA that the calcium activatedpotassium channels SK₄ (KCNN4) expressed in RBC are responsible for themembrane potentials observed in RBC. These experiments confirm that theEtOH opens the hSK₄ and lets the K⁺ permeate out of the cell therebyhyperpolarizing the cell membrane.

This fact is further explained by the modified Goldman-Hodgkin-Katzequation (shown below) as derived by Thiruvengadam (Thiruvengadam, A.Journal of Affective Disorders 65 (2001) 95-99).

$V = {62\mspace{14mu} \log_{10}\frac{{P_{K}/{P_{Na}\left( {K_{o}^{+}/{Na}_{o}^{+}} \right)}} + 1}{P_{K}/{P_{Na}\left( {K_{i}^{+}/{Na}_{o}^{+}} \right)}}}$

This equation shows that the membrane potential V is a function ofrelative potassium permeability P_(K)/P_(Na), extracellular potassiumconcentration K_(o), intracellular potassium concentration K_(i), andextracellular sodium concentration Na_(o). Since the extracellular K_(o)is zero, and Na_(o) is constant, the membrane potential is solely afunction of the intracellular K_(i). If the intra cellular K⁺ decreasesdue to the opening of the channel the cell membrane potential willhyperpolarize according to this equation, explaining the experimentalobservation.

hSK₄ Pore Structure and EtOH action: The calcium activated K⁺ channelstructure consists of six domains. SK channel family is a prime exampleof modular evolutionary protein design. The pore forming unit consistsof the voltage sensing domains that are found in all other voltage gatedK⁺ channels, a pair of transmembrane domains involved in theCa²⁺-activated regulation of the K⁺ conductance, and a unique largeintracellular domain that acts as a sensor for the intracellular Ca²⁺concentration. The amino acid chain forms a transmembrane pore of about6-8 angstroms through which the K⁺ ion (4 angstroms) flows. The aminoacid configuration and location regulates this flow rate andexcitability of this channel. It is known that any mutations affectingthe amino acids forming this pore would affect the K⁺ currents andexcitability (Yang Y et al, J Biol Chem. 2010 Jan. 1; 285(1): 131-141).This pore is closed when RBCs are suspended in K⁺ free buffer as shownby Grygorczyk et al (BIOPHYS. J. Biophysical Society, Volume 45, 1984,693-698).

In order to confirm that the CAK channel opening and closing is involvedin the membrane potential of the RBC used for the membrane potentialratio (MPR™) tests, the CAK channel blockers, quinine and clotrimazolewere added to the test buffer and the membrane potential ratio (MPR™)was determined (FIG. 2). These blockers depolarized the membranepotentials robustly indicating the CAK closing and opening involvementin the membrane potential ratio (MPR™). This result establishes that thecalcium activated potassium channels SK₄ (KCNN4) expressed in RBC areresponsible for the membrane potentials observed in RBC. Addition ofEtOH opens this pore and lets K⁺ ions flow out thereby reducing theintra cellular K⁺ concentration as discussed above. This reduction inthe intra cellular K⁺ concentration hyperpolarizes the cell membrane. Asshown in FIG. 1 the hyperpolarized membrane potentials are significantlydifferent for the three groups of patients who participated in theclinical trials.

Calmodulin (CaM): Calcium activated potassium channels (CAK channels ofwhich SK₄ is a member) are activated by CaM (Fager G. M. et al., J.Biol. Chem. 274(9): 5746-5754 (1999)). Calmodulin, CaM (also calledCa²⁺/CaM) is a widespread and abundant transducer of calcium signalingin cells (Stevens F C, Can. J. Biochem. Cell Biol. 61 (8): 906-10(1983)). It can bind to and regulate a number of different proteintargets, thereby affecting many different cellular functions. Calciumgating in small conductance calcium activated potassium channels (CAKchannels) is the primary mechanism controlling the potassium flowthrough the pores. CaM is responsible for this calcium gating (Fager G.M. et al 1999, The J. Biolo. Chem. Vol. 274, No. 9, pp. 5746-5754). CAKchannels are activated by Ca²⁺/CaM signaling which modulates the openingand closing of hSK₄ channels. Ca²⁺/CaM in turn are modulated by thefollowing two important signaling pathways.

Signaling Pathways: These pathways are the cAMP pathway and the DAGpathway. These two important signaling pathways in the cell areactivated by G-protein coupled receptors (GPCR), which receive thesignal from external stimuli by ligands such as hormones, growthfactors, cytokines, chemokines, neurotransmitters and neurotropins(Nahorski S. R. British Journal of Pharmacology (2006) 147, S38-S45).

cAMP Signaling Pathway: Cyclic adenosine monophosphate (cAMP, cyclic AMPor 3′-5′-cyclic adenosine monophosphate) is an important secondmessenger in many biological processes. The cAMP is derived fromadenosine triphosphate (ATP) and is used for intracellular signaltransduction in many different organisms. It works by activating thecAMP-dependent protein kinase called protein kinase A (PKA). Theaddition of cAMP analog 8-CPT promotes the PKA activity (Sandberg M. etal, Biochem. J. 279: 521-527 (1991)). In order to determine whether thecAMP pathway is involved in the membrane potential ratio (MPR™),8-CPT-cAMP (50 μM) was added to the test buffer and the membranepotential ratio (MPR™) values were determined. There was no effect of8-CPT on membrane potential ratio (MPR™) as shown in FIG. 3. This resultshowed that the cAMP pathway is not involved in the processes affectingthe membrane potential ratio (MPR™).

DAG Signaling Pathway: In biological signaling, diacylglycerol (DAG)functions as a second messenger signaling lipid (Nahorski S. R. BritishJournal of Pharmacology (2006) 147, S38-S45). DAG is a product of thehydrolysis of the phospholipid PIP2 (phosphatidyl inositol-bisphosphate)by the enzyme phospholipase C (PLC) (a membrane-bound enzyme) that,through the same reaction, produces inositol trisphosphate (IP₃).Although inositol trisphosphate (IP₃) diffuses into the cytosol,diacylglycerol (DAG) remains within the plasma membrane, due to itshydrophobic properties. The production of DAG in the membranefacilitates translocation of PKC from the cytosol to the plasma membrane(Newton, A. C. Am J Physiol Endocrinol Metab 298:E395-E402, 2010). Henceboth DAG and PKC enzymes play important roles in several signaltransduction cascades.

PKC and Phorbol 12-Myristate 13-Acetate (PMA): PMA is a diester ofphorbol often employed in biomedical research to activate the signaltransduction enzyme protein kinase C (PKC) (Castagna et al 1982, Journalof Biological Chemistry 257 (13): 7847-7851). In order to see if theactivation of PKC has any effect on membrane potential ratio (MPR™), PMAwas added to the test buffer and the MPR™ was measured. As shown in FIG.4, the MPR™ is indeed depolarized indicating the involvement of PKC inthe hSK₄ activation. This figure shows a comparison of the MPR™ valueswith 2.5 μM PMA in the test buffer and those values without PMA. PMAdepolarizes the cells very effectively.

Staurosporine: Staurosporine is a natural product originally isolated in1977 from the bacterium Streptomyces staurosporeus. The main biologicalactivity of staurosporine is the inhibition of protein kinases includingPKC through the prevention of ATP binding to the kinase (Karaman M W,Nat Biotechnol. 2008 January; 26(1):127-32). The PKC inhibitorstaurosporine was added to the test buffer at three differentconcentrations and the membrane potential ratio (MPR™) values weredetermined and shown in FIG. 5. Staurosporine hyperpolarizes themembrane potentials very effectively indicating the role of PKC and theDAG pathway in membrane potentials. The effect of PKC inhibition onmembrane potential ratio (MPR™) is shown in FIG. 5. As shown in thisfigure, staurosporine hyperpolarizes the membrane potential in aconcentration dependent manner.

CaM Kinase II: As discussed earlier, calcium gating in small conductancecalcium activated potassium channels (CaK channels) is the primarymechanism controlling the potassium flow through the pores. CaM isresponsible for this calcium gating (Fager G. M. et al., J. Biol. Chem.274(9): 5746-5754 (1999)). CaM Kinase II is regulated by theCa²⁺/calmodulin complex and is involved in many signaling cascades. CaMKinase II is found in high concentrations in neuronal synapses, and insome regions of the brain it may constitute up to 2% of the totalprotein content. Activation of CaM kinase II has been linked to memoryand learning processes in the vertebrate nervous system. The effects ofCa²⁺ are also important. It cooperates with DAG in activating PKC andcan activate the CaM kinase pathway, in which calcium modulated protein,calmodulin binds to Ca²⁺, undergoes a change in conformation, andactivates CaM kinase II, which has a unique ability to increase itsbinding affinity to CaM by making CaM unavailable for the activation ofother enzymes. In order to see the involvement of Ca²⁺/CaM/Cam Kinase IIin membrane potential ratio (MPR™), the CaM Kinase inhibitor wasinvestigated.

CaM Kinase II Inhibitor AIP: A novel synthetic peptide AIP(Autocamtide-2-related Inhibitory Peptide), a nonphosphorylatable analogof autocamtide-2, was found to be a highly specific and potent inhibitorof calmodulin-dependent protein kinase II (CaM-kinase II) (Ishida et al,J. Biol. Chem. 270, 2163 (1995)). AIP (myristoylated) is the same as AIPbut is N-terminal myristoylated to increase cell permeability. AIPdepolarizes the membrane robustly at a 5 micro M concentration as shownin FIG. 6 again establishing the DAG pathway as the primary signalingprocess.

DAG Kinase Inhibitor: Diacylglycerol kinase (DGK) is a family of enzymesthat catalyzes the conversion of diacylglycerol (DAG) to phosphatidicacid (PA) utilizing ATP as a source of the phosphate. In non-stimulatedcells, DGK activity is low allowing DAG to be used forglycerophospholipid biosynthesis but on receptor activation of thephosphoinositide/DAG pathway, DGK activity increases driving theconversion of DAG to PA. As both lipids are thought to function asbioactive lipid signaling molecules with distinct cellular targets, DGKtherefore occupies an important position, effectively serving as aswitch by terminating the signaling of one lipid while simultaneouslyactivating signaling by another (Merida et al Biochem. J. (2008) 409,1-18). DAG Kinase inhibitor, ALX, (6-[2-[4-[(4-fluorophenyl)phenylmethylene)-1-piperidinyl]ethyl]-7-methyl-5H-thiazolo[3,2-a]pyrimidin-5-one)was found to inhibit diacylglycerol kinase in human red blood cellmembranes (de Courcelles et al., J. Biol. Chem. 260(29): 15762-15770(1985)). ALX depolarizes the membrane potential as shown in this figureat three different concentrations including 2.5 μl, 5 μl and 7.5 μl.

Cause of the differences in membrane potential ratio (MPR™): FIG. 1shows that there are differences in the mean values of MPR™ for thenegatives, BDs, and ADHDs. Those skilled in the art recognize that thesedifferences arise from the differential modulation of the DAG pathway inthe patients with these disorders. For example a genome-wide associationstudy implicated the diacylglycerol kinase eta (DGKH) and several othergenes in the etiology of bipolar disorder (Baum et al, Mol Psychiatry.13(2): 197-207 (2008)). In the Baum study, the authors found that, outof 37 SNPs selected for individual genotyping, the strongest associationsignal was detected at a marker within the first intron of DGKH.Similarly PKC has been implicated in BD by several authors (Hahn andFriedman, Bipolar Disorders 1999: 2: 81-86).

However, these authors failed to recognize the important role of the DAGpathway for modulating membrane potentials and excitabilities in thesedisorders. Moreover, the cells from actual patients could be used totrace this pathway and show how these three groups of patients differfrom each other. The present inventor has recognized that this pathwaycould be used to develop diagnostic markers and therapeutic drugs usingthe patient cells instead of animal models. Also, the use of the DAGpathway opens the way to modulate the several molecules that affect thispathway.

In one embodiment of the present invention, the agent that altersdiacylglycerol signaling may be selected from, but not limited to,calcium-calmodulin (Ca²⁺/CaM) kinase inhibitors, calcium-calmodulin(Ca²⁺/CaM) promoters, diacylglycerol kinase inhibitors, protein kinase Cinhibitors, calcium-calmodulin (Ca²⁺/CaM) antagonists, andcalcium-calmodulin (Ca²⁺/CaM) promoters.

For instance, the PKC inhibitor may be selected from, but not limitedto, phorbol 12-myristate 13-acetate (PMA),3-(1H-indol-3-yl)-4-[2-(4-methylpiperazin-1-yl)quinazolin-4-yl]pyrrole-2,5-dione(Sotrastaurin orAEB07), 13-hydroxyoctadecadienoic acid (13-HODE),aprinocarsen, bisindolylmaleimide, bryostatin-1, butein, calphostin C,7,8-dihydroxycoumarin, 4′-demethylamino-4′-hydroxystaurosporine,rottlerin, ruboxistaurin, staurosporine, and verbascoside.

For instance, calcium-calmodulin (Ca²⁺/CaM) antagonists may be selectedfrom, but not limited to A-7 hydrochloride, calmidazolium chloride(R24571), E6 berbamine, fluphenazine-N-2-chloroethane.2HCl, J-8hydrochloride, trifluoperazine.2HCl (Stelazine), phenothiazine,phenoxybenzamine, W-13 Isomer hydrochloride, decyl analog hydrochloride,W-5, and W-7.

For instance, calcium-calmodulin (Ca²⁺/CaM) promoters may be selectedfrom, but not limited to, CaM (G-3), CaM (N-19), CaM (L-20), CaM(FL-149), and CaM (H-149).

For instance, calcium-calmodulin (Ca²⁺/CaM) kinase inhibitors may beselected from, but not limited to, autocamtide-2-related inhibitorypeptide (AIP), CaM Kinase II inhibitor, diisopropylfluorophosphate,galanthamine hydrobromide, (±)-Hhuperzine A, quinacrine dihydrochloride,and pep statin A Methyl Ester.

For instance, calcium-calmodulin (Ca²⁺/CaM) kinase promoters may beselected from, but not limited to, Zic2.

For instance, diacylglycerol kinase inhibitor may be selected from, butnot limited to, diacyglycerol kinase I inhibitors and diacyglycerolkinase II inhibitors. Preferably, the diacylglyercol kinase inhibitorsmay be selected from, but not limited to,6-[2-[4-[(4-fluorophenyl)phenylmethylene]-1-piperidinyl]ethyl]-7-methyl-5H-thiazolo[3,2-a]pyrimidin-5-one(ALX), R59022, amidepsines A, B, and C, and RHC-80267.

Another embodiment of the invention is to provide a diagnostic kit fordiagnosing ADHD or BD, and an agent identifying kit used for identifyinga modulator of diacylglycerol signaling for the treatment of ADHD or BD.For instance, the modulator may include a calcium-calmodulin (Ca²⁺/CaM)kinase inhibitor, a diacylglycerol kinase inhibitor, and a proteinkinase C inhibitor. Preferably, the kit used for identifying a modulatorthat alters calcium-activated potassium channel activity such as hSK₄channel activity. The kits include the buffers described herein, andpreparation thereof.

The buffers that may be used in the diagnostic and agent identifyingmethods of the present invention include, but are not limited to, thebuffers described in U.S. Pat. Nos. 7,425,410 and 7,906,300 which arehereby incorporated by reference in their entirety. These buffersinclude regular K⁺-containing buffer which is a HEPES buffer to whichpotassium has also been added (5 mM KCl, 4 mM NaHCO₃, 5 mM HEPES, 134 mMNaCl, 2.3 mM CaCl₂, and 5 mM glucose) and is also referred to as“regular” or “stock” buffer at a pH of 7.4 (range of 7.3 to 7.5).

The present invention also provides an improved assay, device andmethods of using the same to diagnose BD and ADHD.

The assay uses a reference buffer or regular buffer and a test buffer.The “reference buffer” or “regular buffer” contains only Na⁺, Ca²⁺, andHEPES without any other reagents. The “test buffer” containing nopotassium (K⁺-free buffer) is a HEPES buffer without potassium (4 mMNaHCO₃, 5 mM HEPES, 134 mM NaCl, 2.3 mM CaCl₂, and 5 mM glucose) andwith a K⁺ channel altering agent, at a pH of 6.8 (range of 6.6 to 7.0).The test buffer may also contain 30 μM ethacrynic acid dissolved in EtOHas solvent.

K⁺ channel altering agents include, but are not limited to, ethanol,amphetamine, ephedrine, cocaine, caffeine, nicotine, methylphenidate,lithium, δ-9-tetrahydrocannibinol, phencyclidine, lysergic aciddiethylamide (LSD), mescaline, or combinations thereof. Preferably, theK⁺ channel altering agent is ethanol.

When the cells are suspended in a K⁺ free buffer the intracellular K⁺leaks out. However the Na⁺K⁺-ATPase pump cannot compensate for this lossby bringing in the K⁺ from outside the cell since there is no K⁺outside. This causes the K⁺ channel to shut down. When a K⁺ channelaltering agent (such as ethanol) is added, the agent affects the K⁺channel, for instance, by opening the K⁺ channel, thus further reducingthe membrane potential. This opening depends on the patients from whomthe cells were drawn. This difference is reflected in the MPR™ obtainedas well as in the pathway governing the cell membrane potentials andexcitabilities of the excitable cells.

The following examples are provided for illustrative purposes only andare in no way intended to limit the scope of the invention.

Example 1

Discovering Diagnostic Markers for BD and ADHD

This invention discloses that the DAG signaling pathway modulates theMPR™ in BD and ADHD. Those skilled in the art recognize that thisinvention can be usefully employed in discovering new diagnostic markersby measuring the differential expression of these markers in the cellscollected from BD and ADHD patients. It is demonstrated by thisinvention that the MPR™ can be modulated by the promoters and inhibitorsof DAG, PKC and Ca²⁺/CaM. It is contemplated that this could be used forthe discovering additional diagnostic markers for these illnesses usingpatients' cells leading to personalized treatment.

Example 2

Developing Drugs for BD and ADHD

Currently lithium is an effective drug for BD where as methylphenidate(trade name Ritalin) is an effective drug for ADHD. Lithium's toxicityand undesirable side effects are the important limitations limiting itswidespread use. Similarly Ritalin is a highly addictive stimulantleading to its abuse by the patients. These limitations incentivize theneed for the development of new and effective drugs for these diseases.Those skilled in the art recognize that the promoters and inhibitors ofDAG, PKC and Ca²⁺/CaM would be potential candidates. It is contemplatedthat they could be used for discovering additional drugs for theseillnesses by using patient's cells. For example, the blood-brain barrier(BBB) excludes many highly hydrophilic compounds. To ensure that theeffective compounds of the invention cross the BBB, if desired, they canbe formulated, for example, in liposomes, or chemically derivatized.Engleton et al (Engleton et al., Peptides 9:1431-1439, 1997) havereviewed the strategies for increasing bioavailability of polypeptidedrugs in the brain, and of methods for determining the permeability ofpolypeptides through the BBB using in vitro and in vivo assays.Strategies that have been successfully used to increase the permeabilityof other neuropeptides through the BBB are particularly contemplated.Furthermore RBCs are good pharmacological models for BD and ADHD. Theinfluence of DAG pathway and its associated molecules affecting the MPR™can be modulated by new drugs for BD and ADHD (Hinderling (1997)PHARMACOLOGICAL REVIEWS Vol. 49, No. 3).

Example 3

In order to verify the CAK channel is involved in the membrane potentialof the RBC used for the membrane potential ratios (MPR™) tests, the CAKchannel blockers, quinine and clotrimazole were added to the test bufferand the membrane potential ratios (MPR™) was determined. The results areshown in FIG. 2. The membrane potential ratios (MPR™) values are shownin box plots. Box 2 shows the increased values of membrane potentialratios (MPR™) with 1 mM quinine in the test buffer as compared to thevalues in box 1 for the test buffer without quinine. Similarly boxes 3,4 and 5 show the results for clotrimazole (CLTX). Box 3 represents noCLTX, while box 4 for 2.5 micro molar CLTX and box 5 for 5 micro molarconcentrations in the test buffer. These blockers depolarized themembrane potentials strongly indicating the involvement of CaK in theMPR™ tests. This result establishes that the calcium activated potassiumchannels hSK₄ (KCNN4) expressed in RBC are responsible for the MPsobserved in RBC.

Example 4

The two most important pathways involved in the regulation of biologicalprocesses in the cell are the cAMP pathway and the DAG pathway. The cAMPpathway was considered first. 8-CPT-cAMP is a cAMP analog that promotescAMP production in cells. In order to determine whether the cAMP pathwayis involved in the membrane potential ratio (MPR™) test, 8-CPT-cAMP wasadded to the test buffer and the membrane potential ratios (MPR™) valueswere determined. As shown in FIG. 3, 8-CPT (50 micro molar) did not haveany effect on the membrane potentials. Based on these results it wasconcluded that the cAMP pathway did not play a role modulating themembrane potential ratio (MPR™).

Example 5

The DAG signaling pathway was considered. One of the important proteinsin this pathway is protein kinase C (PKC). Phorbol 12-Myristate13-Acetate (PMA) is an effective promoter of PKC. FIG. 4 shows theresults of a comparison of the membrane potential ratio (MPR™) valueswith 2.5 μM PMA in the test buffer and those values without PMA. PMA wasshown to depolarize the cells very effectively. This result establishesthat the DAG signaling pathway is involved in modulating the membranepotential ratio (MPR™).

Example 6

In order to further confirm the involvement of the DAG pathway inmodulating the membrane potential ratio (MPR™), the PKC inhibitor,staurosporine, was added to the test buffer at three differentconcentrations (250 nM, 500 nM and 750 nM) and the membrane potentialratio (MPR™) values determined and shown in FIG. 5. Staurosporine wasshown to hyperpolarizes the membrane potentials very effectivelyindicating the role of PKC and the DAG pathway in modulating themembrane potential ratio (MPR™).

Example 7

Another important enzyme in the DAG signaling pathway is CaM Kinase IIwhich participates in the Ca²⁺/CaM modulation of the calcium-activatedpotassium (CAK) channels. AIP (Autocamtide-2-related InhibitoryPeptide), a novel synthetic peptide, is a CaM Kinase II Inhibitor. Anonphosphorylatable analog of AIP, AIP (myristoylated), was found to bea highly specific and potent inhibitor of calmodulin-dependent proteinkinase II (CaM-kinase II). AIP (myristoylated) is the same as AIP but ismyristoylated at the N-terminus to increase cell permeability. As shownin FIG. 6, AIP depolarizes the membrane potential robustly at a 5 μMconcentration, establishing the critical role of the DAG signalingpathway in modulating membrane potential ratio (MPR™).

Example 8

FIG. 7 shows the effect of DAG Kinase inhibitor, ALX,(6-[2-[4-[(4-fluorophenyl)phenylmethylene)-1-piperidinyl]ethyl]-7-methyl-5H-thiazolo[3,2-a]pyrimidin-5-oneon the membrane potential ratio (MPR™). ALX depolarized the membranepotential at three different concentrations including 2.5 μl, 5 μl and7.5 μl establishing the critical role of DAG signaling pathway inmodulating the membrane potential ratio (MPR™).

Example 9

Blood samples from a patient were suspended in a reference buffer(reference buffer sample) as well as in a test buffer (test buffersample) with 3,3′-dihexyloxacarbocyanine iodide (DiOC₆) dye, incubated,spun, drained and the supernatants resuspended in their respectivebuffers without the dye. The resuspended buffer samples were thendistributed in three separate 96 well plates and tested in a PlateReader for fluorescence intensity. The Plate Reader recorded a datamatrix of each of the 96 well plates and the data matrix was transferredto a Template to calculate the ratio between the test buffer sample andthe corresponding reference buffer sample. The resulting ratios werecalculated to determine the mean value, the standard deviation and thecoefficient of variation. This procedure was repeated two more times andthe resulting mean value, standard deviation and the coefficient ofvariation calculated in the same manner. The Membrane Potential Ratio(MPR™) obtained from the mean values was 0.781 (with a standarddeviation of 0.014 and coefficient of variation of 1.76). Based on theMPR™ value of 0.781, the patient was diagnosed to have ADHD (with agreater than 97% probability).

1. A method of diagnosing bipolar disorder (BD) in a human patientcomprising obtaining a test ratio of a mean membrane potential of afirst population of human patient cells incubated in vitro in thepresence of an agent that alters diacylglycerol signaling and in theabsence of K⁺, to a mean membrane potential of a second population ofthe human patient cells incubated in vitro in the absence of the agentthat alters diacylglycerol signaling and in the presence of K⁺ orabsence of K⁺; comparing the test ratio to (a) and/or (b): (a) is acontrol ratio of a mean membrane potential of control human cells knownto not have said BD incubated in vitro in the presence of the agent thatalters diacylglycerol signaling and in the absence of K+, to a meanmembrane potential of the control human cells known incubated in vitroin the absence of the agent that alters diacylglycerol signaling and inthe presence of K+ or absence of K+, (b) is a bipolar control ratio of amean membrane potential of bipolar control human cells known to havesaid BD incubated in vitro in the presence of the agent that altersdiacylglycerol signaling and in the absence of K+, to a mean membranepotential of the bipolar control human cells incubated in vitro in theabsence of the agent that alters diacylglycerol signaling and in thepresence of K+ or absence of K+; and diagnosing the human patient tohave BD when: (1) the test ratio is not significantly different from thecontrol ratio of (a), (2) the test ratio is increased towards thecontrol ratio of (a) in comparison to the bipolar control ratio of (b),or (3) the test ratio is increased in comparison to the bipolar controlratio of (b).
 2. The method of claim 1, wherein the agent that altersdiacylglycerol signaling is selected from the group consisting of acalcium-calmodulin (Ca²⁺/CaM) kinase inhibitor, a diacylglycerol kinaseinhibitor, and a protein kinase C inhibitor.
 3. The method of claim 1,wherein the agent affects calcium-activated potassium (CaK) channels. 4.A method of diagnosing attention deficit hyperactivity disorder (ADHD)in a human patient comprising obtaining a test ratio of a mean membranepotential of a first population of human patient cells incubated invitro in the presence of an agent that alters diacylglycerol signalingand in the absence of K+, to a mean membrane potential of a secondpopulation of the human patient cells incubated in vitro in the absenceof the agent that alters diacylglycerol signaling and presence of K+ orabsence of K+; comparing the test ratio to (a) and/or (b): (a) a controlratio of a mean membrane potential of control human cells known to nothave said ADHD incubated in vitro in the presence of the agent thatalters diacylglycerol signaling and in the absence of K+, to a meanmembrane potential of the control human cells incubated in vitro in theabsence of the agent that alters diacylglycerol signaling and in thepresence of K⁺ or absence of K⁺, (b) an ADHD control ratio of a meanmembrane potential of ADHD control human cells known to have said ADHDincubated in vitro in the presence of the agent that altersdiacylglycerol signaling and in the absence of K+, to a mean membranepotential of the ADHD control human cells incubated in vitro in theabsence of the agent that alters diacylglycerol signaling and in thepresence of K+ or absence of K+; and diagnosing the human patient tohave ADHD when: (1) the test ratio is not significantly different fromthe control ratio of (a), (2) the test ratio is decreased towards thecontrol ratio of (a) in comparison to the ADHD control ratio of (b), or(3) the test ratio is decreased in comparison to the ADHD control ratioof (b).
 5. The method of claim 4, wherein the agent that altersdiacylglycerol signaling is selected from the group consisting of acalcium-calmodulin (Ca²⁺/CaM) kinase inhibitor, a diacylglycerol kinaseinhibitor, and a protein kinase C inhibitor.
 6. The method of claim 4,wherein the agent affects calcium-activated potassium (CaK) channels.7-37. (canceled)
 38. A method of diagnosing bipolar disorder (BD) in ahuman patient comprising obtaining a test ratio of a mean membranepotential of a first population of human patient cells that expresshuman calcium-activated potassium-channels hSK₄, incubated in vitro inthe presence of an agent that alters human calcium-activatedpotassium-channels hSK₄ activity and in the absence of K⁺, to a meanmembrane potential of a second population of the human patient cellsthat express human calcium-activated potassium-channels hSK₄, incubatedin vitro in the absence of the agent that alters that express humancalcium-activated potassium-channels hSK₄ activity and in the absence ofK⁺; comparing the test ratio to (a) and/or (b): (a) is a control ratioof a mean membrane potential of control human cells known to not havesaid BD incubated in vitro in the presence of the agent that altershuman calcium-activated potassium-channels hSK₄ activity and in theabsence of K⁺, to a mean membrane potential of the control human cellsincubated in vitro in the absence of the agent that alters humancalcium-activated potassium-channels hSK₄ activity and in the absence ofK⁺, (b) is a bipolar control ratio of a mean membrane potential ofbipolar control human cells known to have said BD incubated in vitro inthe presence of the agent that alters human calcium-activatedpotassium-channels hSK₄ activity and in the absence of K⁺, to a meanmembrane potential of the bipolar control human cells incubated in vitroin the absence of the agent that alters human calcium-activatedpotassium-channels hSK₄ activity and in the absence of K⁺; diagnosingthe human patient to have BD when: (1) the test ratio is notsignificantly different from the control ratio of (a), (2) the testratio is increased towards the control ratio of (a) in comparison to thebipolar control ratio of (b), or (3) the test ratio is increased incomparison to the bipolar control ratio of (b).
 39. The method of claim38, wherein the agent that alters human calcium-activatedpotassium-channels hSK₄ activity is ethanol, amphetamine, ephedrine,cocaine, caffeine, nicotine, methylphenidate, lithium,δ-9-tetrahydrocannibinol, phencyclidine, lysergic acid diethylamide(LSD), mescaline, or combinations thereof.
 40. The method of claim 39,wherein the agent that alters human calcium-activated potassium-channelshSK₄ activity is ethanol.
 41. A method of diagnosing attention deficithyperactivity disorder (ADHD) in a human patient comprising obtaining atest ratio of a mean membrane potential of a first population of humanpatient cells that express human calcium-activated potassium-channelshSK₄, incubated in vitro in the presence of an agent that alters humancalcium-activated potassium-channels hSK₄ activity and in the absence ofK⁺, to a mean membrane potential of a second population of the humanpatient cells that express human calcium-activated potassium-channelshSK₄ incubated in vitro in the absence of the agent that alters humancalcium-activated potassium-channels hSK₄ activity and in the absence ofK⁺; comparing the test ratio to (a) and/or (b): (a) is a control ratioof a mean membrane potential of control human cells known to not havesaid ADHD incubated in vitro in the presence of the agent that altershuman calcium-activated potassium-channels hSK₄ activity and in theabsence of K⁺, to a mean membrane potential of the control human cellsincubated in vitro in the absence of the agent that alters humancalcium-activated potassium-channels hSK₄ activity and in the absence ofK⁺, (b) is a bipolar control ratio of a mean membrane potential of ADHDcontrol human cells known to have said ADHD incubated in vitro in thepresence of the agent that alters human calcium-activatedpotassium-channels hSK₄ activity and in the absence of K⁺, to a meanmembrane potential of the ADHD control human cells incubated in vitro inthe absence of the agent that alters human calcium-activatedpotassium-channels hSK₄ activity and in the absence of K⁺; anddiagnosing the human patient to have ADHD when: (1) the test ratio isnot significantly different from the control ratio of (a), (2) the testratio is decreased towards the control ratio of (a) in comparison to theADHD control ratio of (b), or (3) the test ratio is decreased incomparison to the ADHD control ratio of (b).
 42. The method of claim 41,wherein the agent that alters human calcium-activated potassium-channelshSK₄ activity is selected from the group consisting of ethanol,amphetamine, ephedrine, cocaine, caffeine, nicotine, methylphenidate,lithium, δ-9-tetrahydrocannibinol, phencyclidine, lysergic aciddiethylamide (LSD), mescaline, and combinations thereof.
 43. The methodof claim 42, wherein the agent that alters human calcium-activatedpotassium-channels hSK₄ activity is ethanol.
 44. The method of claim 1,4, 38 or 41, wherein the human patient cells is selected from the groupconsisting of red blood cells and lymphoblasts.